FRAILTOOLS study protocol: a comprehensive validation of frailty assessment tools to screen and diagnose frailty in different clinical and social settings and to provide instruments for integrated care in older adults.

BACKGROUND: Dozens of scales and questionnaires have been used in the detection of frailty; however, a generalized method for its screening and diagnosis is still lacking in clinical settings. FRAILTOOLS´ main objective is to evaluate the usefulness of frailty scales in the detection of frailty in different clinical and social settings, and its integration in management algorithms for the frail older patient. METHODS: FRAILTOOLS is an observational, longitudinal and prospective study with a follow-up of 6, 12 and 18 months. People older than 75 years old will be recruited from three separate clinical settings (acute geriatric wards, geriatric outpatient clinics and primary care) and one social setting (nursing homes). Exclusion criteria include Mini-mental State Examination < 20 points, and a Barthel index < 90 points, except in nursing home residents (< 40 points). The participants will be recruited in Spain, Italy, France, United Kingdom and Poland. The total sample size will be of 1.940 subjects, 97 subjects in each clinical setting by center. A personal interview with each participant will take place to register data on comorbidity (Charlson Index), functional (SPPB, Barthel and Lawton indexes), cognitive (MMSE) and frailty status (Fried Phenotype, Frailty Trait Scale - short version, SHARE-FI, 35-Items Rockwood Frailty Index, Clinical Frailty Scale, FRAIL scale and Gérontopôle Frailty Screening Tool) in the baseline visit, month 12 and month 18 visit of follow up. At 6 month a phone call will be made to assess whether there have been falls and to check the vital status. DISCUSSION: Currently, the usefulness of certain assessment tools in social and clinical settings have not been properly assessed, including their ability to predict the individual risk for different adverse outcomes, which is the main interest in daily practice. The FRAILTOOLS project concentrates on providing screening and diagnostic tools for frailty in those settings where its prevalence is the highest and where efforts in prevention could make a significant change in the trend towards disability. TRIAL REGISTRATION: Comprehensive validation of frailty assessment tools in older adults in different clinical and social settings (FRAILTOOLS), NCT02637518 (date of registration: 12/18/2015).

Preventing frailty with the support of a home-monitoring and communication platform among older adults-a study protocol for a randomised-controlled pilot study in Sweden.

BACKGROUND: POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. METHODS: The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried's criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants' physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants' perception of health and level of care received, and healthcare professionals' workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. DISCUSSION: The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design. TRIAL REGISTRATION: ClinicalTrials.gov. REGISTRATION NUMBER: NCT04592146 . October 19, 2020.

[Positive Project: maintenance and improvement of intrinsic capacity involving primary care and caregivers through a home monitoring system and a telematic services platform.] / Proyecto POSITIVE: Mantenimiento y mejora de la capacidad intrínseca que involucra a la atención primaria y a los y las cuidadores a través de un sistema de monitorización domiciliaria y una plataforma telemática de servicios.

POSITIVE (acronym for Maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is an EIT Health funded project. Its main objective is to make available to the elderly population, caregivers and the different clinical professionals involved in their care, both primary and hospital care, a home monitoring system that allows a better management and treatment of frailty, in order to maintain or improve the intrinsic capacity of the elderly, as well as to avoid disability through a telematic platform of services. The POSITIVE technological ecosystem allows data collection and remote monitoring of the state of pre-fragility and fragility in a community environment, enabling early interventions aimed at preventing disability and dependence. The home monitoring system consists of a series of questionnaires on the state of health, and 3 sensors that measure variables with high predictive power of adverse events: gait speed, power in the lower extremities and involuntary weight loss. With this system, older people are under constant supervision. In addition, POSITIVE has an automatic system of personalized prescription of physical exercise based on the VIVIFRAIL program, as well as a nutritional plan and monitoring of functional status. Using the platform's services, caregivers can be aware of any impairment. For their part, primary care professionals receive alarms related to potentially dangerous decreases in intrinsic capacity, giving them the possibility to adjust treatments accordingly with the help of a decision support system while the geriatrics service can be involved if deemed necessary.

POSITIVE (acrónimo de Maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) es un proyecto financiado por fondos EIT Health. Tiene como objetivo principal poner a disposición de la población mayor, de los cuidadores y de los diferentes profesionales clínicos implicados en su cuidado, tanto de Atención Primaria (AP) como de hospitalaria, un sistema de monitorización domiciliaria que permita un mejor manejo y tratamiento de la fragilidad, con la finalidad de mantener o mejorar la capacidad intrínseca de las personas mayores, así como de evitar la discapacidad a través de una plataforma telemática de servicios. El ecosistema tecnológico POSITIVE permite la recolección de datos y la monitorización remota del estado de pre-fragilidad y fragilidad en un entorno comunitario, habilitando intervenciones tempranas dirigidas a prevenir la discapacidad y la dependencia. El sistema de monitorización domiciliaria consiste en una serie de cuestionarios sobre el estado de salud, y 3 sensores que miden variables con alto poder predictivo de eventos adversos: velocidad de la marcha, potencia en las extremidades inferiores y pérdida involuntaria de peso. Con este sistema, las personas mayores se encuentran bajo constante supervisión. Además, POSITIVE cuenta con un sistema automático de prescripción personalizada de ejercicio físico basado en el programa VIVIFRAIL, así como un plan nutricional y seguimiento del estado funcional. Utilizando los servicios de la plataforma, los que cuidan pueden estar al tanto de cualquier deterioro. Por su parte, los profesionales de AP reciben alarmas relacionadas con disminuciones potencialmente peligrosas de la capacidad intrínseca, dándoles la posibilidad de ajustar los tratamientos en consecuencia con la ayuda de un sistema de apoyo a la toma de decisiones a la vez que se puede involucrar al servicio geriatría si se considera necesario.

Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study.

Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.

Evaluación de la calidad de los consentimientos informados de los servicios de los hospitales de nivel III-IV de Lima y Callao / Consent forms used in the different services of hospitals of III-IV level of Lima and Callao

Objetivo: Evaluar la calidad de los formatos de consentimiento médico informado para cirugía mayor utilizados en los diferentes servicios de los hospitales de nivel IIIûIV de Lima y Callao. Material y métodos: Estudio descriptivo, cualitativo y transversal. Obtenidos los formatos de consentimiento médico informado para cirugía mayor utilizados en los servicios de los hospitales de nivel III - IV del Lima y Callao; se evaluó su calidad contrastándolos con una plantilla de requisitos elaborada con base en la literatura. Resultados: De los 28 formatos de consentimiento médico informado para cirugía mayor de 20 hospitales de nivel IIIûIV en Lima y Callao evaluados, 14,2 por ciento cumplían con más del 75 por ciento de los requisitos; 57,2 por ciento, con 75-50 por ciento; y 28,6 por ciento, con menos del 50 por ciento. Los requisitos acerca del procedimiento y sus características estuvieron ausentes en más del 75 por ciento de los formatos. Los formatos de los hospitales pertenecientes al Ministerio de Salud (MINSA) cumplieron en promedio con 12 requisitos (rango 4-21); los de las Fuerzas Armadas (FFAA), con 17 (rango 14-18); y los del EsSALUD, con 18 (rango16-22). Conclusiones: Los formatos de CMI de los servicios de los hospitales de nivel IIIûIV de Lima Callao evaluados no presentan uniformidad entre ellos y no garantizan que el paciente ha sido completa y correctamente informado ni que se ha respetado su autonomía en la toma de decisión. Los formatos de CMI del MINSA fueron los más deficientes y los que presentaron mayor variabilidad de calidad. Se propone un modelo de CMI para ser tomado como base por los diferentes servicios de hospitales para la elaboración de futuros CMI.